Lecture 13 - Dementia And Delirium Flashcards by Callum Donoher

What is dementia?

A chronic progresssive syndrome of insidious onset where theres progressive destruction of neurons

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What are the 4 types of dementia?

Alzheimer disease
Vascular dementia
Lewy-body dementia
Frontotemporal dementia

Aids related dementia

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What is thought to be the main 2 causes of Alzheimer dementia?

Formation of:

-Plaques
-Tangles

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What forms the plaques in Alzheimer dementia?

Beta amyloid plaques

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What forms the tangles that’s thought to cause Alzheimer Dementia?

Tau proteins

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What is the pathophysiology of plaque formation in Alzheimer disease?

Amyloid precursor protein broken down by beta secretase leading tot formation of INSOLUBLE B amyloid plaques which aggregate

Normally amyloid precursor protein broken down by. Alpha and gamma secretase into soluble wastes

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What is the downside to beta amyloid plaques forming in Alzheimer dementia?

Thought to induce inflammation
Neuronal death

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What is thought to be the pathological process behind the formation of tangles in Alzheimer dementia?

Tau protein tangles form due to hyper phosphorylation of Tau

Likeli caused by Beta amyloid plaques

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What is the normal function of Tau proteins?

They stabilise microtubules in the neuronal cytoskeleton

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What are the macroscopic changes to the brain that occur during Alzheimer disease?

Which area is typically affected first?

General brain atrophy (Hippocampus is often affected first)

Narrowing of gyri
Widening of sulci
Ventricular enlargement

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What neurotransmitter levels decline in Alzheimer disease and why?

Acetylcholine (ACh)

Since new memory making is impaired and ACh needed for processing memory and learning

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What are the general class of drug used to try and treat Alzheimer disease and why?

Cholinesterase inhibitors (donepezil)

Help increase level of already declined ACh

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What are the 3 types of Alzheimer dementia?

Sporadic
Familial
Trisomy 21 (Down syndrome linked)

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What is the most common cause of Alzheimer disease?

Sporadic

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What is thought to be the casuative gene in familial Alzheimer disease?

PSEN 1/2

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What are the symptoms of Alzheimer disease?

Slow developing

Short term memory loss (hippocampus)
Motor and language then affected
Long term memory loss
Disorientation
Immobilisation

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What is thought to be the main cause of death related to Alzheimer disease?

Death usually related to the fact that the patient is immobile

(E.g more likely to get chest infections like pneumonia and die)

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How is Alzheimer dementia diagnosed?

Diagnosis of EXCLUSION

Need to be sure no other disease process can cause symptoms:
-hypothyroidism
-Hypercalcaemia
-B12 deficieny
-Delirum

CT scan

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What treatment is given for advanced Alzheimer dementia and why?

Memantine

Is a glutamate receptor antagonist
Levels of glutamate increase as neurones die so memantine protects the nerve cells from the high levels of glutamate

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What are some general cognitive symptoms of dementia?

What lobe would be involved with each symptom?

Impaired memory (Temporal lobe)
Impaired orientation (temporal lobe)
Impaired learning (temporal lobe)
Impaired judgement (frontal lobe)

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If a patient has behavioural symptoms associated with their dementia, which lobe has likely been affected?

Frontal lobe

Sexual disinhibition
Aggression

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What is the difference between visual and auditory hallucinations and persecutors delusions?

V and A hallucinations are false perceptions
Whereas
Persecutors delusions are false beliefs

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What type of neurones are mainly affected in Alzheimer dementia?

CHOLINERGIC
Noradrenergic
Serotonergic

What is Lewy Body Dementia?

Dementia which then goes on to develop. Parkinsonian like symptoms

How does the speed of developmetn of Lewy Body dementia compare to the speed of onset of Alzheimer dementia?

Lewy body dementia = more rapid onset

What is thee cause of Lewy body dementia?

Misfolding of Alpha synuclein proteins

Where are alpha synuclein misfolded protiens deposited to cause the dementia type symtpoms?

Cortex

Where are alpha synuclein misfolded proteins deposited to cause parkinsonian like features?

Substantia nigra

What do the misfolded synuclein proteins aggreate to form?

Lewy bodies

What are the early cognitive symtpoms of Lewy body dementia?

Distressing hallucinations (small people and furry animals) Depression REM sleep disorders (sleepwalking and talking)

What are some later parkinsonian symtpoms of Lewy body dementia?

Bradkinesia Resting tremor Stiffness

What is the treatment for Lewy body dementia?

Based on symptoms Levodopa (dopamine analogue)

Why do you not give dopamine antagonists (antipsychotics) for Lewy body dementia?

Can cause neuroleptic malignant syndrome which is a psychiatric emergency

What are the signs/symptoms of neuroleptic malignant syndrome?

Fever Encephalopathy Elevated creatine phosphokinasse Rigidity

What is fronto-temporal lobe dementia?

Frontal and temporal lobe atrophy

What are the signs and symtpoms of fro to-temporal lobe dementia?

Behavioural disinhibition Innappropriate social behaviour Loss of motvaiotn without depression Non fluent Broca’s aphasia This are all mainly due to frontal lobe atrophy

What is thought to be the pathophysiology of fro to-temporal lobe dementia?

Aggregated proteins and Tau protein hyper-phosphoryaltion

What happens as a result to damage to the frontal lobe and then temporal lobe in front-temporal dementia?

Frontal: -behavioural and emotional changes -disinhibition Temporal: -language impairment

What is seen on MRI with fro to-temporal dementia?

Frontal/temporal atrophy Ventricualr enlagremnt

What is vascular dementia?

Where cognitive impairment is caused by cerbrovascular disease (multiple mini strokes)

What are the risk factors for vascular dementia?

Any risk factors increasing risk of CVD: Previous stroke MI Hypertension AFIB Hypercholesterolaemia Diabtes Smoking

How does vascular dementia present?

Depends on area of brain affected

How does Vascualr dementia present on CT head?

Paler areas of infarcted cerebal tissue

How is vascular dementia treated?

Treat the risk factors (AIFB hypertension)

What is the pathology of AIDS/HIV dementia?

HIV infected macrophages cross the blood brain I barrier leading to damage oof neurones Its the viral proteins damaging the brain not any opportunistic infections

What symptoms can AIDs dementia cause?

Behaviour Memory Thinking (psychomotor retardation) Movement (cerebellar involvement) Ataxia Dysarthria Incontinence

Why is HIV/AIDs dementia increasing?

People with HIV and AIDs are living longer so more cases are being seen

How is AIDs dementia managed?

Bio-psycho-social model Bio: Acetylcholinesterase inhbitors (donepezil) NMDA antagonists (memantine) Social Explain diagnosis sensitively Driving

What is delirium?

An acute confusional state which is an acute fluctuating syndrome of disturbed consciousness attention and perception

What are the features of deliurm?

Rapid onset confusion Clouded consciousness Fluctuating course Transient visual hallucinations Often exaggeretaed emotional responses

What are the 2 types of delirium?

Hypoactive Hyperactive

What are some features of hypoactive delirum?

Withdrawn Quiet Sleepy

What are some features of hyperactive delirium?

Restless Agitated Aggressive

What arer some causes of delirium?

Drugs Epilepsy /electolyte imbalance Liver failure /low oxygen Infection Retention(urine/faecal) Intracranial Uraemia Metbolism

What is the treatment of delirium?

Minimise/treat precipitating factors Encourage normal day and night cycle Allow wandering if safe Medication is last resort (Haloperidol)

Go to slide 29 and label delirium vs dementia